声脉冲辐射力弹性成像对甲状腺实性结节的诊断价值

Diagnostic Value of Acoustic Radiation Force Impulse Elastography in Solid Thyroid Nodules

目的评估声脉冲辐射力弹性成像(acoustic radiation force impulse imaging,ARFI)技术不同指标对甲状腺实性结节良恶性鉴别诊断价值。方法对142例患者的168个甲状腺实性结节行ARFI声触诊组织成像(virtual touch tissue imaging,VTI)及声触诊组织定量(virtual touch tissue quantitfication,VTQ)两种技术检查,以VTI弹性分级≥Ⅳ级判断为恶性结节评估诊断效能;评估结节及非病灶组织VTQ所测剪切波速度(sheer wave velocity,SWV)平均值、最大值、中位值及最小值的诊断效能。结果根据受试者工作特征(receiver operating characteristic,ROC)曲线得出甲状腺良恶性结节SWV平均值、最大值、中位值及最小值的最佳诊断截断值分别为2.62 m/s、3.07 m/s、2.59 m/s、2.20 m/s,曲线下面积分别为0.80、0.78、0.71、0.60,敏感度分别为61%、61%、49%、46%,特异度为89%、87%、88%、80%,准确性分别为76%、74%、70%、64%;以VTI弹性分级≥Ⅳ级判断甲状腺实性结节良恶性具有统计学意义(P=0.000),其敏感度、特异度、准确性均为84%。结论 ARFI的VTQ技术SWV平均值、最大值定量诊断效能较高,对于甲状腺实性结节良恶性鉴别,VTI定性优于VTQ定量诊断价值,两者各有优势,两者结合常规超声应用对甲状腺实性结节的鉴别诊断有较大帮助。

Objective To evaluate the value of different index of acoustic radiation force impulse elastography（ARFI）in the diagnosis of benign and malignant thyroid nodules.Methods A total of 142 patients with168 solid thyroid nodules accepted virtual touch tissue imaging（VTI）and virtual touch tissue quantitfication（VTQ）examination of ARFI.Elasticity of VTI≥Ⅳ grade level was considered as malignant.Shear wave velocity（SWV）of nodule and non-nodule tissue were measured for 7 times.Average,maximum,median and minimum SWV were analyzed.Results According to receiver operating characteristic（ROC）curve,the optimum diagnosis cutoff of SWV average,maximum,median and minimum were 2.62m/s,3.07m/s,2.59m/s,2.20 m/s.Areas under the curve were 0.80,0.78,0.71,0.60.Sensitivity were 61%,61%,49%,46%,Specificity were 89%,87%,88%,80%,accuracy were 76%,74%,70%,64%separately.VTI≥Ⅳgrade level to differentiate benign and malignant thyroid nodules had significant difference（P=0.000）whose sensitivity,specificity and accuracy were all 84%.Conclusion Average and maximum SWV have higher diagnostice value compared with median and minimum SWV.VTI has better diagnosis value than VTQ for differential diagnosis of solid thyroid nodules.